HomeMy WebLinkAboutFOREST CREEK LT 1Forest Creek
Lot 1
#015-292-49
Municipality of Anchorage
On -Site Water and Wastewater Program • (907) 343-7904 Page 1 of 3
ON-SITE WASTEWATER INSPECTION REPORT
Permit Number: OSP191015 PID Number: 015-292-49
Dwelling: 9 Single Family (SF) ❑ Duplex (D) ❑ Multiple (SF and/or D) Project: ❑ New X Upgrade
Name:
Andrew S. Wakefield
ABSORPTION FIELD
❑ Deep Trench ❑ Shallow Trench ❑ Bed ❑ Mound
Address
10161 Our Rd. Anchorage, AK 99507
❑ Other
Phone
Number of Bedrooms
Soil Rating
Total depth from original grade
(907) 563-5656
5
EXISTING GPD/SF
Ft.
LEGAL DESCRIPTION
Depth to pipe invert from original grade
Ft.
Gravel depth beneath pipe
Ft.
Subdivision Block Lot
Forest Creek 1
Fill added above original grade
Ft.
Gravel length
Ft.
Township Range Section
Gravel width
Ft.
Beds: Number of Lines
Distance between lines
Ft.
SEPARATION DISTANCES
To
Septic
Absorption
Lift Station
Holding
Sewer
Total absorption area
Number of trenches
Dist. between trenches
From
Tank
Field
Tank
Line
Ft
Ft.
Well
>100'
N/A
N/A
N/A
>25'
TANK 9 Septic ❑ S.T.E.P. ❑ Holding ❑ Other
Manufacturer
Anchorage Tank
Capacity
1500 Gal.
Surface Water
>'
100
N/A
N/A
N/A
Material
Number of compartments
Lot Line
>10'
N/A
N/A
N/A
Steel
2
NA
Foundation
>10'
N/A
N/A
N/A
LIFT STATION
Manufacturer
Capacity
Curtain Drain
None
N/A
Gal.
Remarks Insulation was used over septic tank.
Pump on level at
in.
Pump off level at
in.
High water alarm at
in.
Pump make and model
Electrical Inspections performed by
PIPE MATERIAL House to tank D3034 Tank to D3034
drainfield
Installer
GLW
Drainfield D3034. CO/MT
Inspector J. Williams
BENCH MARK (Assumed elevation) 100 ft
Inspection15 5/6/19
Location and description
dates: 2nd
aro 4th
Garage slab
COMMUNITY DEVELOPMENT DEPARTMENT APPROVAL
Engineer's Stamp
Conditional Approval:
OF
Date
����P,,.••°°°"
'e 49th
. ...... .... ....p.....m
6
.u..nan..nu.....u..a.uvvu..uau..mmum�
%n MICHAEL E. ANDERSON e
/)_6�.6
�
�^ �v�
��C% '•� No. CE -4381 ��
,,, 10/28/19 e••°°
Fp m.............
Approved Date -021
#o P� ®�
inspection Keport_y-i-iz.aoc
PROFILE AS-BUILT
(NO SCALE)
83.8
79.6
84.5
88.5FCOSV1 SV22CO1500 GAL
SEPTIC TANK
83.65
PERMIT # OSP191015 PID # 015-292-49
FOREST CREEK LOT 1
10/28/19
2" INSULATION
1
I•
10' T&E EASEMENT
X
z
� I
II
30.00'
I I
II
I
I \ I
PLOT PLAN ___ AS BUILT —X SCALE 1
Lot 1
40,122 s.f
NOTE: PAVED PARKING
ENCROACHES INTO
ADJACENT RIGHT—OF—WAY
Qt
u
A
5�
G�
z
� I
II
30.00'
I I
II
I
I \ I
PLOT PLAN ___ AS BUILT —X SCALE 1
Lot 1
40,122 s.f
NOTE: PAVED PARKING
ENCROACHES INTO
ADJACENT RIGHT—OF—WAY
I
Lot 2
10' T&E EASEMENTS
METAL FENCE
i'46"E 299.42'
\ SEPTIC PIPES
1
WELL -
.. ___ .._. ,. —._.._. _
Lang & Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax
Professional Land Surveyors kenOlongsurvey.com
jonathanOlongsurvey.com
I hereby certify that I have surveyed the following described property:
Lot 1, FOREST CREEK SUBDIVISION (Plat No. 2005-83)
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the Day of —�a�->cU �__, "(tid"_tip_, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
.ASPHALT..
PAVEMENT
WOODEN FENCE
r]
SEE
"HOUSE DETAIL
GRAVEL
1
I
I
PATIO
I
Lot 5
NOTE: RETAINING WALL
ENCROACHES ONTO
ADJACENT LOT
Lot 6
WOODEN FENCE
I J./
II
I
„J
N 89'56'45"WI 299.42' —
WOODEN FENCE
10' UTILITY EASEMENTS
/ I
Lob 4A2
Alaska 99515-3049
0F A.��S�4�
I
49TH v,
KE .. NG
940440 Z.Ls°� 02
Qp„ ESSIONA� _
AECC963
FISCHER
Lot 3A5
S�1B 1VISION
I
2.0
5.3'
HOUSE DETAIL
SCALE: 1"=30'
Qt
5�
G�
�O
Q
I
Lot 2
10' T&E EASEMENTS
METAL FENCE
i'46"E 299.42'
\ SEPTIC PIPES
1
WELL -
.. ___ .._. ,. —._.._. _
Lang & Associates, inc. (907) 522-6476 Phone
(907) 522-4625 Fax
Professional Land Surveyors kenOlongsurvey.com
jonathanOlongsurvey.com
I hereby certify that I have surveyed the following described property:
Lot 1, FOREST CREEK SUBDIVISION (Plat No. 2005-83)
Anchorage Recording District, Alaska, and that the Improvements situated thereon are
within the property lines and do not encroach onto the property adjacent thereto, that
no improvements on the property lying adjacent thereto encroach on the surveyed
premises and that there are no roadways, transmission lines or other visible
easements on said property except as indicated hereon.
Dated this the Day of —�a�->cU �__, "(tid"_tip_, at Anchorage, Alaska
It is the responsibility of the owner to determine the existence of any easements,
covenants, or restrictions which do not appear on the recorded subdivision plat.
.ASPHALT..
PAVEMENT
WOODEN FENCE
r]
SEE
"HOUSE DETAIL
GRAVEL
1
I
I
PATIO
I
Lot 5
NOTE: RETAINING WALL
ENCROACHES ONTO
ADJACENT LOT
Lot 6
WOODEN FENCE
I J./
II
I
„J
N 89'56'45"WI 299.42' —
WOODEN FENCE
10' UTILITY EASEMENTS
/ I
Lob 4A2
Alaska 99515-3049
0F A.��S�4�
I
49TH v,
KE .. NG
940440 Z.Ls°� 02
Qp„ ESSIONA� _
AECC963
FISCHER
Lot 3A5
S�1B 1VISION
I
2.0
5.3'
HOUSE DETAIL
SCALE: 1"=30'
to I,
14FiUNICIPALITY OF ANC110RAGE
0 "ite Water & Wastewater Proyriirn
n
PC) Box '196650 4700 Elmore Pond
Phone: (907)343-7904 Fm: (907)343-799/
On -Site Wastewater Disposal Systean Permit
Permit Number: OSP191015 Effective Date: 1/23/2019
Work Type: SepticTank Upgrade Expiration Date: '1/23/2020
Tax Code Number-. 01529249000
Site Legal Address: FOREST GREEK LT 'I G:2537
Site Mailing Address* '10161 OUR RD, Anchorage
Owner: WINSLOW MARK P 50% & I...ot Size in Sq Ft: 40122
Design Engineer: FORGE ENGINEERING Total Bedrooms: 5
This permit is for the construction of:
El Disposal Field R Septic Tank El Holding Tank El Privy 0 Private Well El Water Storage
All construction shall be in accordance with:
1. The attached approved design,
2. All requirements specified in Anchorage Municipal code Chapters 15,55 and 15,65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72) and Drinking Water Regulations (18AAC80)
3. The wastewater code requires inspections during the installation. The engineer shall notify the Development
Services Department per AMC 15.65. Provide notification by calling (907) 343-7904 (2417),
4. From October 15 to April '15, a Subsurface soil absorption system under construction during freezing weather
shall be either:
a. Opened and Closed on the same day, or
b. Covered, sealed, and heated to prevent freezing
Received By:
Issued By.
Date:
i/rDate:
EPL,9NS
MUNICIPALITY OF ANCHORAGE
Community Development Department Phone: 907-343-7904
Development Services Division Fax: 907-343-7997
On -Site Water & Wastewater Program
ON-SITE SEWER/WELL PERMIT APPLICATION
Parcel I.D. 015-292-49
Property owner(s) Andrew S. Wakefield
Mailing address 10161 Our Rd. Anchorage, AK 99507
Site address 10161 Our Rd
Day phone
Legal description (Sub'd., Block & Lot) Forrest Creek Lot 1
Legal description (Township, Range & Section)
Lot Size 40,122 Sq. Ft. Number of Bedrooms 5
APPLICATION IS FOR: APPLICATION IS AN:
TYPE OF DWELLING:
(M all that apply)
Absorption Field ❑ Initial ❑
Single Family (SF) ❑X
Septic Tank 1ZUpgrade ❑X
(w/wo ADU)
Holding Tank ElRenewal ElDuplex
(D) El
Privy ❑
Multiple Dwellings ❑
(SF and/or D)
Private Well ❑
Water Storage ❑
THIS APPLICATION INCLUDES A VARIANCE / WAIVER REQUEST FOR:
Distance:
I certify that the above information is correct. I further certify that this is in accordance with
applicable Municipal Codes.
U
(Signature of property owner or authorized agent)
Permit/Rush Fees: 1919
Date of Payment: /ei2-1 Iq
Receipt Number: 61050D
Permit No. (15PI9 1 1[' -
Permit App_:• :- :'-._c
Waiver Fees:
Date of Payment:
Receipt Number:
Waiver No.
January 22, 2019
MOA Development Services, On-Site Water & Wastewater Program
4700 Elmore Rd
Anchorage, AK 99507
1/22/19
Subject: Forest Creek Lot 1 – 10161 Our Rd.
Septic system design
Dear On-Site Services Engineer:
The owner of the above lot intends to build an addition to his home that encroaches over the
existing septic tank, so we are submitting this permit application for the installation of a new septic
tank that does not interfere with the addition. The attached site plan identifies the location of the
home as well as the existing well, adjacent wells and septic location. No conflicts exist between
this proposed system and any other well or septic system, whether on this lot or adjacent lots.
The ground surface on the lot slopes toward the northwest. Stormwater drainage will not impact
this septic system.
The septic tank will be a minimum of 100’ from all wells and surface water, 10’ from the
foundation, and more than 5’ away from the septic trench.
Please refer to the attached plan. If this design is followed, there will be no adverse impacts to
adjacent properties.
Sincerely,
Benjamin Schiller, PE
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191015, Rebecca Carroll, 01/23/19
// // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // // //
NOTE:
NO SLOPES >25% WITHIN 50' OR SURFACE WATER WITHIN 100' OF THE PROPOSED
SEPTIC
SYSTEM
ALL WELLS ON SURROUNDING LOTS WITH IMPACTS TO THIS PROPERTY ARE
SHOWN.
NO
CONFLICTS
WITH
WELLS OR SEPTIC SYSTEMS.
CO
-
CLEANOUT
2CO
-
DOUBLE
CLEANOUT
FCO
-
FOUNDATION
CLEANOUT
FD
-
FLOW
DIVERTER
VALVE
MH
-
MANHOLE
MT
-
MONITORING
TUBE
SV
-
SEPTIC
VENT
TH
-
TEST
HOLE
LEGENDOUR ROADFOREST CREEK LOT 1
1"=50'
FEET
0 50 100
Jan 22, 2019 10' T&E EASEMENT10' T&E EASEMENT10'
UTILITY
EASEMENT
5-BDRM
HOME
DECOMMISSION
EXISTING
TANK
IN
ACCORDANCE
WITH
MOA
CODE
EXISTING TRENCH
100' RADIUS
EXISTING WELL
INSTALL NEW
1500
GALLON SEPTIC
TANK
INSTALL DOUBLE
CLEANOUT AFTER TANK
NEW
ADDITION
NEW FOUNDATION
CLEANOUT
Municipality of Anchorage
On-site Water and Wastewater
REVIEWED FOR CODE COMPLIANCE
OSP191015, Rebecca Carroll, 01/23/19
l\
Municipality of Anchorage
Development Services Department
Building Safety Division .. .
Onsite Water and Wastewater Program, 4700 Elmore Road
P.O. Box 196650 Anchorage, AK 89507 Page of
www .c"' chorage.ak.us (907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM AND/OR WELL INSPECTION REPORT
Permit Number. SW080024
PID Number. 015-29249
wn.
The Dittrich Company
Wastewater System: ❑� New ❑Upgrade
Ada
P.O. Box 90411 Anchorage, AIL 99509
ABSORPTION FIELD
pl� 345.6277
or a ' 5
O D..p Ttrrm ld Swww Tram O SW O Mane 0 DFRr
LEGAL DESCRIPTION
Sa+R+mu
Tar D.qn". mpnr QMW
1.2 GPD,Fr
6-9 FI
0� Lac 1 6�rmwrac
Forest Creek
D.oa M Pip. . aora alw p.M
Grn Moa MrwM PM
4.5 FL
4 FL
Tmn" R.V.
S. .
Fi apMa.ma mg." Vb
Gravr Lrrpn.
2-3 Ft.63
Ft.
Well: 21 New ❑Upgrade
wr.'r w.
DRtr axwwrMa.
5 Ft.
FL
Cn.rncrm (P . A e. 4
Tar D nm
Caaa o.
Tau" .awgxm r.a
PP. M.ww
Private
272
n
272 FL
630 Fl
IASTM 03034 PVC
Daw
Dow Drr.a
swop wa L.
II w
Dr. Imre.a
MW Drilling
4/19/08
238 Fc
Glacier Masonry
4/162008
yawPure
Su u
Da" Hegm a.� Grana.
I TANK
10 GPM
253 - Ft.
2 FL
SEPARATION DISTANCES
0 Septic ❑ Holding ❑ S.T.E.P. ❑ Other.
To
Septic
ADsorptlon
LM
Holding
lubiriPrivate
'°"'0
y
Ftom
Tank
Field
Station
Tank
SrwrrUna
Anchorage Tank
11,500 ON
wu
>100'
>100'
NIA
WA
>25'
Mr.w
Steel
Irnr.r r CarpumarM
Two (2)
sMr.a.w"
>100'
>100'
NIA
N/A
LIFT STATION
s.
wua.
Lo U"'
>5'
>10'
NIA
NIA
Gr
'KovwM a
•Pure air Yw.L
h.Yn wrr rarma
Fantl"'"'
>5'
>10'
WA
N/A
h
M
h
C~ Drat
None
Noted
Puny MM. a Moat
El.canr hrap. Prtamua q
Rwa.nu
BENCH MARK
Lamson ua D.•aipaa^.
Garage Slab
100.0 FL
Inspections performed by: A. Harala
Dates: 10 4/162008
.,E�adtr,rer, w
,e �(� • v;,,•.44 Ep!
a �Q.••••s �>
�� '•
2nd
2 4/162008
r !7: 4
Development Services
Department Approval
*; 49-1H
•,
Conditional Approval
Date:
S�
•,••,
0 1, I MICHAEL E ANDERSON••
-
op J� ; CE-4381 •\��
r�,F�
Reviewed and approved by:
ate:
PR-0iCSS10�A�' a:'
i ilko...o�.``
(R. watt
rn.o,� 1 �y4�
N N POW I M.M.Q0.00 N -� r +"•••'' '"ti -V��1
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Municipality of Anchorage
DEVEOPMENT SERVICES DEPARTMENT
4700 South Bragaw Street Anchorage, AK. 99519-6655 - 343-7904
On -Site Wastewater Disposal System or Well Inspection Report
Permit Number. SWO80024
v
U
82.1
85.8
93.0
rN
N
UU
1,500 Gallon
Septic Tank
84.7
Geotextile Fabric
78.1 Drainfield Rock
I
i
74.1-�
— 64.1
No Groundwater
5121/07
PROFILE AS -BUILT -
No Scale
Page 3 of 3
PID No. 015-292-49
czS
78.1
zt � �oNF
ZL
COMMENTS
PERCOLATION RATE I (mb•e M• ) PERC HOLE DUIMETER
TEST RUN SETWEENTFT .'AND FT
PERFORMED BY: j I 1wI r✓lL CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAUGUIDELINES IN EFFECT ON THIS DATE. DATE: Q- Z L - O is
a
Municipality of Anchorage
*J' �+j'JYEYIJ�SEA41 *•�
Development Services Department
Building Safety Division
�•_..`. •»• •» �•••
On-SheWater and Wastewater PrO ram
9
""""""' "" ••• ••••••••
E ANDERSON �`04, AW
4700 South Bragaw St.
P.O. Box 195650 Anchorage, AK 99519.6550
�AVt]iAa
0 ciJ, :� , CE -4381
w (90anchor7904Y..us
# e.,.. 40*0 ?.LZ O.�j`�Z.`4 .
t,1�►giiw����'.
Soils Log - Percolation Test
,,�' /
Performed For. ' ►{,
yi ffK " 4o.
Date Performed: 3 3 f
Legal Description: {�(/1
l�/j�eT.. Township, Range, Section:,...___
Slope
Sde Plan
Depth
(Feet
e•�
OZr
1-
2-
3_
�M
4-
1 �-
e
... 6 Rw!u•trs
7-
8-
WAS GROUND WATER
9-
ENCOUNTERED? �_
•
5
10-
IF YES. AT WHAT DEPTH7 L
0
11-
Depth to Water After
Monitoring? E
12-
Dale:
13-
14_
Reading Date Gross Time I
Not Time
Depth to Water Net Dino
15-
?J
G. Co IIv
17-
}aLt3o
/
16-
ibt
3
I
20-
5%4�1I
I<rV
zt � �oNF
ZL
COMMENTS
PERCOLATION RATE I (mb•e M• ) PERC HOLE DUIMETER
TEST RUN SETWEENTFT .'AND FT
PERFORMED BY: j I 1wI r✓lL CERTIFY THAT THIS TEST WAS
PERFORMED IN ACCORDANCE WITH ALLSTATE AND MUNICIPAUGUIDELINES IN EFFECT ON THIS DATE. DATE: Q- Z L - O is
a
89/18/2008 11:51 9073453287 MW DRILLING PAGE 02/02
M -W Drilling, Inc.
*P.O. Box 110378*Anchorcge, AK 99511•
•907-345-4000 • 907-345-3287 Fax•
Job No. 08.120
Well Owner. Dittrich
Legal Description: Lot 1, f
GROUNDWATER WELL AS -BUILT & LOG
Use of Well: Domestic
CONSTRUCTION
Hole Depth: 272' Casing Size: a' Cased To: 272' Material: A 53 Steel
Drill Method: Air otary Wall: =.
Well Completion: Open end X Screen Perforated Pert. Method:
Screen/ Perforation description:
Grout Notes: ( 2) Sack(s) of No. Bentonite granuies
Notes:
Disinfected: No Meth
Well Development Method Air Surge
Notes:
Static water level (SWL) 238' below top of casing (TDC).
Well yield test at 10 Tag.—per minute (GPM) for 1 hour(s) with l00% of drawdown (DD) from static level(SWL).
Method: Air Litt —
Stan Date: / /O8 Completion Date: 4/24/08
Pump Install Date: 8/27/08
w�p—q
pthof test from top
Details; of formations penetrated, size of material, colorand miscellaneous details.
0
2.5
TO
TO
3
5
Casing Stick Up
Overburden
5
TO
108
Gravel: silty with Inter -bedded, cobbly zones
108
TO
111
Water Gravel: Silty, l-2gpm, med(um to fine
111
TO
253
Gravel: Silty, cobbly, brown
253T0
259
Water Gravel: medium, 2-3 gpm
259
TO
266
Gravel: silty, wet, light brown
266
70
272
Water Gravel: medium to coarse, 10gpm
TO
T
TO
I►YNE-EAMTISERG
S-'- MW6tDr9lhlaJnc
N0A C&5W Mama Gmimdr*K C0nbX or
TO
To
TO
TO
Cantredors irre�JAo.
TO
09/18/2008 15:17 9073453287 IMI DRILLING PAGE 03/03
Development Services Department
Building Safety Division
0 ay
On -Site Water & Wastewater Program P*
4700 Elmore Road
P.O. Box 196650
Mark Begteh Anchorage, AK 99507
Mayo! eww.mvni.erd�en9itt
(907)343-7904
Pump Installation Log
Well Drilling Permit Number: SWj2_1�_c92L4 Date of Issue: _q_$— 08
Parcel Identification Number: 292 ^ yQ
Legal Description
Lot 1. Foneet Creek Subdivision
Anchorage, AK 99509
Pump Installation Date: &27,08
Pump Intake Depth Below Top of Well Casing: 253
Pump Manufacturer's Name: arunfos
Pump Model: losoE1s.100
Pump Size Kone) hp
Pitless Adapter Burial Depth: 10' feet
Piticss Adapter Manufacturer's Name: s^enens0n
Pitlam Adapter Installer: &w Drtuing. Inc,
Well Disinfected Upon Completion? ❑ Yes ® No
Method of Disinfection:
Comments,
Pump Installer Name: rv1-wmitiing.lm
feet
Jarele DeIrk:h dbe DinAch Company
10161 Our Road (P.O. Bow 90,411)
Anchcrege. AK 99309
Attention: The pump installer shall provide a pump installation log to the DSD within 30 days of pump Installation.
MUNICIPALITY OF ANCHORAGE \
Development Services Department
On -Site Water 8 Wastewater Program ` t
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650 �t
(907) 343-7904
ON-SITE WASTEWATER DISPOSAL SYSTEM / WATER SUPPLY PERMIT
Initial
Permit Number: SW080024
Legal Description: FOREST CREEK LOT 1
Design Engineer: 0014 ANDERSON ENGINEERING
Owner Name: THE DITTRICH COMPANY
Owner Address: PO BOX 90411
ANCHORAGE. AK 99509 -
Date Issued: Apr 03, 2008
Expiration Date: Apr 03, 2009
Parcel ID: 015-29239
IOIL4PI
Site Address: NHN OUR ROAD
Lot Size: 40122 SQ. FT.
Total Bedrooms: 5 Permit Bedrooms: 5
This permit is for the construction of:
❑; Disposal Field [?] Septic Tank ❑ Holding Tank ❑ Privy Q Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations ( 18AAC80 ).
3. The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
THE ENTIRE SUBSURFACE DISPOSAL FIELD IS NOT WITHIN A 30 FOOT RADIUS OF A PERCOLATION TEST
OR GROUNDWATER MONITORING. THE ENGINEER NEEDS TO DO A COMPLETE SOILS LOG PRIOR TO THE
CONSTRUCTION OF THE SEPTIC FIELD. PLEASE SUBMIT STAMPED AND SIGNED RESULTS WITH THE
AS -BUILT INSPECTION REPORT. IF THE RESULTS REQUIRE A DESIGN CHANGE, CONSTRUCTION OF THE
SYSTEM WILL STOP PENDING ON-SITE REVIEW AND APPROVAL.
Received By:
Date:
el - 0
\ Municipality of Anchorage
• -� Development Services Department ���" : n �•
Building Safety Division
On -Site Water and Wastewater Program '
4700 Bragaw Street
P.O. Box 196650
Anchorage, Alaska 99519-6650
www.muni.org/onsite
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
Parcel I.D. 015-29249
Property owner(s) The Dittrich Company Day phone 632-5790
Mailing address P.O. Box 90411 Anchorage, AK Zip Code 99509
Site address N 4i fJ Our Road Zip Code 99516
Legal description (Sub'd., Block & Lot) Forest Creek, Lot 1
Legal description (township, Range & Section)
Lot Size 40.122 Sq. Ft. Number of Bedrooms Five (5)
THIS APPLICATION IS FOR (® all that apply): THIS APPLICATION IS AN:
Absorption Field Q Initial Q
Septic Tank Q Upgrade ❑
Holding Tank ❑ Renewal ❑
Privy ❑
Private Well
Water Storage ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
1q—jL1 .0
(Signature of property owner or authorized agent)
Permit/Rush Fees: 'Waiver Fees:
Date of Payment: 3 /p
Date of Payment:
Receipt Number. 105n9 5 Receipt Number.
(Rev. 11105)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
MEMORANDUM
DATE: April 1, 2008
TO: Deb Wockenfuss
FROM: Mike Anderson, P.E.
SUBJECT: Lot 1, Forest Creek Subdivision
Septic System Construction Permit
The following information is provided to resolve comments concerning our application
for a well and septic system permit for Lot 1, Forest Creek Subdivision:
1. The subdivision was originally called Dittrich Subdivision. The File No. was S-
11250-1.
2. Existing soil logs were submitted with the original application. Logs from
adjacent lots can be found in the subdivision file.
3. No well was located on the lot during the subdivision phase. An application for
construction of a well was made, but the well was not constructed.
4. Easements have been added to the Area Map.
5. The existing well on Lot 3A5 Fischer Subdivision has been added. All wells
within 200' of the new absorption system are now shown on the Area Map.
6. An additional test hole will be completed prior to construction of the new
absorption trench. The new trench will be constructed entirely within the 30'
radius of this hole. Construction of the system will stop pending further review
and approval if soils encountered in the test hole vary from other test holes on
the lot.
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
March 12, 2008
Municipality of Anchorage
Development Services Department
On -Site Water and Wastewater Program
4700 South Bragaw Street
Anchorage, AK 99519-6650
Subject: Lot 1, Forest Creek Subdivision
Septic System Design and Permit Application
Impacts to Adjacent Properties
Dear Onsite Services Engineer:
The owner of Lot 1, Forest Creek Subdivision intends to construct a new five -bedroom
home on the lot. We are therefore requesting a permit be issued for the construction of
a new well and septic system to accommodate the home. The attached Site Plan and
backup documentation identify the location and configuration of the proposed well and
septic system along with the alternate site. Also identified on the plans are the existing
wells and septic systems on surrounding lots. No conflicts exist between the proposed
well and septic system and wells or septic systems on adjacent lots. Drainage arrows
are shown on the site plan showing the grade and direction of flow on the lot. The
drainage pattern will not be changed as a result of this project.
The test holes were placed on the lot in the area of the absorption trench and alternate
site during the subdivision phase. Additional test holes will be required as these holes
are further than 30' from the new sites due to placement of the well on the lot. We are
requesting the test holes be placed during the construction phase of the new absorption
trench. All test holes in the subdivision have revealed the same or similar soils. The
logs indicate well graded sand (SP/SW) to depths of 18'. The percolation rate of the
soil was determined to be between 1 and 5 minutes per inch. No groundwater was
found during the placement of the test hole and none was noted during the monitoring
period. An application rate of 1.2 gallons per day per square foot was used in the
design of the absorption system. We are proposing to place a new 1,500 -gallon septic
tank and a 63' long by 5' wide by 4' effective depth absorption trench to treat and
dispose of the effluent generated in the house. The elevation of the distribution line in
the absorption trench will be 4' below the surface and the total depth will be 8'. A
minimum of 3' of fill or 2" of insulation and 2' of fill will be placed over the absorption
trench and 4' over the septic tank.
Lot 1, Forest Creek Subdivision
March 12, 2008
Page Two
The ground surface on the lot in the area of the septic system slopes to the northwest.
The new trench will be constructed parallel with the slope as much as possible in
conformance with Municipal requirements. The new septic system will be constructed a
minimum of 100' from all wells and any surface water and 10' the proposed and existing
water services in the area. The system will be constructed outside the Class B Wetland
Boundary shown on the Site Plan.
If the system is constructed in accordance with our design the following statements
apply:
The system, if constructed as designed, will have no adverse impact on the wells
in the area or those to be constructed in the future.
2. The system, if constructed as designed, will have no adverse impact on existing
septic systems in the area or those to be constructed in the future.
3. The system, if constructed as designed, will have no adverse impact on reserve
space, either surface or subsurface, on any lots located in the area.
4. The system, if constructed as designed, will have no adverse impact on drainage
patterns in the area. The current drainage pattern will be maintained.
Sincerely, w n —
Michael E. Anderson, P.E.
Attachments
TRACT A
(VACANT)
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LOT 4
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LOT 2
1
LOT 5
,
(VACANT)
LOT 6
LOT t
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LOT 1, FOREST CREEK SUBDIVISION
DESIGN FACTORS: SYSTEM REQUIREMENTS:
Five Bedroom Home 5' Wide Trench System
Perc. Rate: 1.2 Min./Inch 1,500 Gallon Septic Tank
Application Rate: 1.2 GPD/SF 4' Drainfield Rock
5 Bedrooms X 150 GPD/1.2 GPD/SF (Application Rate) = 625 SF Absorption Area
625 SF/5 LF (Width)•.5 (Red. Factor) = 62.5 LF Trench Length
THEREFORE: Construct a 63' Long x 5' Wide x 4' Effective Depth Absorption Trench at the Location
Shown. Flow Line Elevation in Trench to be 4' Below Original Ground Surface. Total Depth to be
8' Below Existing Ground. Provide 4' Cover Over Septic Tank and 3' Cover Over Absorption
Trench. Maintain 100' Separation from Welts in the Area.
NOTE:
Natural
Backfill
3'6"
G.5
4'0"
I 5'
-;
ICAL DEE
(NO
Geotextile
Fabric
Perforated
'C (Holes Down)
Drainfield Rock
TRENCH SECTION
Grade Area Over Trench to Drain Away.
Minimum 6' Separation From Bedrock.
Minimum 4' Separation From Groundwater.
Minimum 100' Separation From Wells in the Area.
Minimum 100' Separation From Surface Water or Streams.
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH13RAGAW STREET ANCHORAGE, ALASKA 99519-6650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: Jamie Dittrich DATE PERFORMED: 2/92004
LEGAL DESCRIPTION: Proposed Lot 1. Dittrich Subdivision
j�j��TTj�TT�� TEST HOLE # 11 SL—OPE—SITE PLAN
IIIIIIIII OG/OL I I
'1111:11
0
3-
5-
6 56
7a
8
9
10
11
17J .° O
SP/SM
Poorly Graded to
Silty Sand
Olive
Dry
WAS GROUNDWATER
GROSS
TIME
NET
TIME
ENCOUNTERED?
No
S
2:15
L
IF YES, WHAT DEPTH?
1
0
DEPTH OF WATER
None
P
AFTER MONITORING:
2:26
E
DATE:
2242004
2
2:36
s7 -1v -77 -,Do ve
Dry
_49th _
0. %M c�woemaw
♦ No. eea i
e444ea';;71�.
BOH @ 20'
SEE SITE PLAN
FOR TEST HOLE LOCATION
Varies
READING DATE
GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start 222
2:15
8.75'
1
2:25
10
Dry
8.75'
Recharge
2:26
8.5'
2
2:36
10
Dry
8.5'
Recharge
2:37
8.5'
3
2:47
10
Dry
8.5'
PERC RATE:1_1 MIN./INCH PERC. HOLE DIAMETER:8"
TEST RUN BETWEEN 6 FT. AND 6 T.
COMMENTS: Test Hole Pre Soaked Prior to Test
TEST PERFORMED BY: ALAN HARALA I, MICHAEL F. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/242004
MUNICIPALITY OF ANCHORAGE
DEVELOPMENT SERVICES DEPARTMENT
4700 SOUTH BRAGAW STREET ANCHORAGE, ALASKA 99519-6650
SOILS LOG - PERCOLATION TEST
PERFORMED FOR: Jamie Dittrich DATE PERFORMED: 2/9/2004
LEGAL DESCRIPTION: Proposed Lot 1. Dittrich Subdivision
�jT�� TEST HOLE # 12 SLOPE SITE PLAN
II1111111 OG/OL II
I
2
a
3
4 °
5-
6-
7-
8-
9 67 89
4
10
11
12
13
a
SP/SM
Poorly Graded to
Silty Sand
Olive
WAS GROUNDWATER
ENCOUNTERED? No
Dry IF YES, WHAT DEPTH?
DEPTH OF WATER None
AFTER MONITORING:
DATE:2/24/2004
srs •a#y
r
49th
BOH @ 21'
S
L
0
P
E
SEE SITE PLAN
FOR TEST HOLE LOCATION
Varies
READING
DATE GROSS
TIME
NET
TIME
DEPTH OF
WATER
NET
DROP
Start
2/22 2:50
8,75-
1
3:00
10
Dry
8.75'
Recharge
3:01
8.5'
—2—
—1-3:10-1-10—
_Dry
Recharge
3:11
8.5'
3
3:21
10
Dry
8.5'
PERC RATE:1_1 MIN./INCH PERC. HOLE DIAMETER: 8_
TEST RUN BETWEEN 5 FT. AND 8 T.
COMMENTS: Test Hole Pre Soaked Prior to Test. 28% to 30% Slope Down Hill From Test Hole.
TEST PERFORMED BY: ALAN HARALA I, MICHAEL F. ANDERSON, CERTIFY THAT THIS TEST WAS PERFORMED IN ACCORDANCE
WITH ALL STATE AND MUNICIPAL GUIDELINES ON THIS DATE: 2/24/2004
ON-SITE WASTEWATER DISPOSAL SYSTEM
CONSTRUCTION AND MATERIAL SPECIFICATIONS
SUBJECT: LOT 1, FOREST CREEK SUBDIVISION
GENERAL:
1. The scope of this project includes the procurement and placement of a new
1,500 -gallon septic tank at the location shown on the Site Plan. Work also
includes the construction of a new 63' long X 5' wide X 4' effective depth
absorption trench at the location also shown on the Site Plan. The
distribution line in the trench will be placed at 4' below the existing ground
surface. Total depth of the trench will be 8' below the existing ground
surface. The new absorption trench and septic tank must be placed a
minimum of 100' from all private wells and any surface water in the area and
10' from the water service line proposed for the lot. A minimum of 3' of cover
is required over the absorption trench and 4' of cover over the septic tank.
2. Construction shall be in accordance with the approved site plan, design
drawings, Municipal Permit with any special provisions or conditions, and all
applicable State and Municipal Wastewater Disposal Regulations.
3. The Contractor shall be responsible for obtaining all underground utility
locates and for the layout of the septic system and verification of the location
of all lot lines. The Contractor must also verify the location of wells in the
area and assure that the separation distances are met.
4. Unless specifically agreed otherwise, the contractor shall be responsible for
final grading areas subsequently depressed from soil settling. Property
owner shall be responsible for revegetation of affected areas unless
specifically agreed otherwise.
5. Contractors installing wastewater disposal systems must be certified by the
Municipal Development Services Department Building Safety Division On Site
Water and Wastewater Program for system installations. Owners installing
their own systems must receive prior approval from the On Site Water and
Wastewater Program before beginning system installation.
SEPTIC TANK INSTALLATION
A new 1,500 -gallon septic tank must be procured from an approved source
and installed at the location shown.
2. A septic tank is to be constructed by a certified septic tank manufacturer.
Construction shall include two 4" cleanouts for pumping access.
Lot 1, Forest Creek
March 12, 2008
Page 2 of 3
3. The septic tank shall be sufficiently bedded to prevent settling or shifting of
the tank.
4. All standpipes on the septic tank shall extend a minimum of 12 inches above
final grade.
5. Tanks installed without 4' of cover shall have a minimum of 2" of direct burial
insulation.
6. A foundation cleanout shall be installed one to four feet from the building
foundation. Two cleanouts are required between the tank and the drainfield.
7. Final grading over the tank shall be such that a positive slope exists away
from the septic tank.
DRAINFIELD CONSTRUCTION:
1. The drainfield shall be constructed to the dimensions shown on the design.
The bottom of the trench shall be within 2" of level.
2. Distribution piping must be placed level with perforations down atop a level
bed of drainfield rock. Rock should then be placed over the pipe to provide a
minimum of 2" of cover.
3. A silt barrier or geotextile fabric must be placed between the drainfield rock
and the natural soil backfill.
4. Monitor tubes must be 4" in diameter and installed at the locations shown on
the design. The portion below ground must be perforated.
5. Contractor shall verify the septic tank and drainfield are a minimum 100' away
from any private water wells in the area, 150' from a Class "C" Well or 200'
from any community well.
6. Direct bury insulation must be placed over the distribution system if less than
3' of backfill depth is available. Finish grade over the trench must be
mounded to prevent settlement or depressions.
7. Grade area surrounding the absorption trench to drain away.
8. A minimum 2' of accepting soil is required below the drainfield rock for a 5'
wide trench. Contractor shall verify this condition prior to placement of the
rock. All pockets of unacceptable materials must be removed and replaced.
Lot 1, Forest Creek
March 12, 2008
Page 3 of 3
MATERIAL SPECIFICATIONS:
Septic tanks must be constructed by a municipally approved septic tank
manufacturer.
2. The following pipe materials are approved for use in septic system
installations in the Municipality of Anchorage:
Cast Iron (perforated and solid), ASTM D3034 or P.V.C. (perforated and
solid), ASTM F810 or H.D.P.E. (perforated, but not solid) and ASTM D2662
or A.B.S. (perforated and solid).
Insulation shall be at least 2" thick extruded direct burial polystyrene (Dow
Chemical Co. Styrofoam HI or equal).
4. Septic tank inlets and outlets shall be fitted with watertight couplings
(Caulder, Femco, or equal).
A permeable geotextile fabric (Typar, Mirafi or equal) must be installed
between the final drain rock layer and the native soil layer.
6. All drain rock shall be .5" to 2.5" in diameter with less than 3% passing the
#200 sieve.
INSPECTIONS:
Municipal Ordinance requires a minimum of two inspections. These inspections
must be conducted under the supervision of a professional engineer registered
in the State of Alaska. The first inspection must be conducted after the
excavation of trenches, beds or pits and before the installation of any gravel. A
septic tank may be set in place, but may not be backfilled.
The second inspection must be conducted after the placement of the geotextile
fabric, gravel, distribution piping, standpipes, cleanouts and insulation. No
backfill should be in place at the time of inspection.
Contractor shall provide a copy of all field survey layout and construction notes
for use in preparing the certified as -built of the completed system.
r
MUNICIPALITY OF ANCHORAGE
Development Services Department
On -Site Water & Wastewater Program
4700 South Bragaw Street
P.O. Box 196650, Anchorage, AK 99519-6650
(907) 343-7904
ON-SITE WATER SUPPLY PERMIT
Initial
Date Issued: Jun 18, 2004
Expiration Date: Jun 18, 2005
Permit Number: SWO40208 +ii1b1TrR(e _ Lo7; f 1 Parcel ID: 015-292-29
Legal Description: FtSGHER-13116 J.QJ
Design Engineer: 0014 Anderson Engineering
Owner Name: DITTRICH COMPANY
Site Address: OUR RD
Lot Size: 0 SO. FT.
Owner Address: PO BOX 90411 Total Bedrooms: 1 Permit Bedrooms: 1
ANCHORAGE. A 99509 -
This permit is for the construction of:
❑ Disposal Field ❑ Septic Tank ❑ Holding Tank ❑ Privy Private Well ❑ Water Storage
All construction must be in accordance with:
1. The attached approved design.
2. All requirements specified in Anchorage Municipal Code Chapters 15.55 and 15.65 and the State of Alaska
Wastewater Disposal Regulations (18AAC72 ) and Drinking Water Regulations (18AAC80 ).
3, The engineer must notify DSD at least 2 hours prior to each inspection. Provide notification by calling
(907) 343-7904 ( 24 hours ). ( Not required for a Water Supply Permit only ).
4. From October 15 to April 15, a subsurface soil absorption system under construction during freezing weather
must be either: A. Open and closed on the same day.
B. Covered, sealed, and heated to prevent freezing.
5. The following special provisions.
- WHEN THE WELL HAS BEEN COMPLETED AND SATISFACTORY WATER PRODUCTION HAS BEEN
DETERMINED, THE WELL DRILLER SHALL PLACE AN APPROVED SANITARY SEAL ON THE WELL HEAD AND
NO PITLESS ADAPTER OR PUMP SHALL BE INSTALLED UNTIL AN APPROVED WASTEWATER DISPOSAL
SYSTEM HAS BEEN CONSTRUCTED.
TN 'S r6ttp .i T rs Ford THE 1'e0P0j.'G ArTTr2 r c r/ sG G.o7 i
Received By:
Date: G — ZZ -0 y
Issued By: l l l r Date:'60
Parcel I.D.
Municipality of Anchorage
Development Services Department
Building Safety Division
On -Site Water and Wastewater Program
4700 South Bragaw SL
P.O. Box 196650 Anchorage, AK 99519-6650
www.ci.anchorage.ak.us
(907)343-7904
ON-SITE SEWER/WELL PERMIT APPLICATION
FOR A SINGLE FAMILY DWELLING
sr-
_Zy Scy(E2 Lo7 ,
Number SW
Property owner(s) Dittrich Company Day phone 636.8730
Mailing address (1) P.O. Box 90411 Anchoraae, AK 99509
Mailing address (2) Zip Code
Legal description (Lot, Block & Sub'd.) Lot 1. Block 2, Fischer Subdivision • (Lot 1, Dittrich Sub. Proposed)
Legal description (Section, Township & Range)
Lot Size TBD Acres/Sq.Ft.
THIS APPLICATION IS FOR:
Number of Bedrooms TBD
Sewer Only ❑ Well Only ED
Sewer and Well ❑ Water Storage ❑
Sewer Upgrade ❑
THIS PROPERTY CONTAINS:
Hot Tub ❑ Jacuzzi ❑
Swimming Pool ❑ Water Softening Unit ❑
Therapy Pool ❑
certify that the above information is correct. I further certify that this application is being made for a
Single Family Dwelling and is in accordance with applicable Municipal Codes.
(Signature of property owner or authorized agent)
Permit Fees: a I '� Waiver Fees:
Date of Payment: ( D I q I Date of Payment:
Receipt Number. <-� 1 Receipt Number.
(Rev. 12100)
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
FAX MEMO
DATE: 6116/2004
TO: Dan Roth
WITH: MoA/On Site Services
FROM: Mike Anderson
SUBJECT: Dittrich Subdivision
Test Well Locations
MESSAGE:
Attached is the revised drawing showing the location of the wells for the subject lots.
Let me know what you think.
2 Pages Being Transmitted. Please call 522-7773 If not complete.
1 LJ I VY LLL_ LV V/'1 I I V I V J
wac 1'-100'
G TEST MOLE LOCAnON5
ANDERSON ENGINEERING
P.O. BOX 240773
ANCHORAGE, AK 99524
MEMO
DATE: 6/9/2004
TO: Joe Goodall
WITH: MoA/OnSite Water and Wastewater
FROM: Mike Anderson
SUBJECT: Lots 1 and 2, Block 2, Fischer Subdivision
Well Construction Permits
Lots 1 and 2 of Fischer Subdivision are currently being subdivided into 6 lots and a
tract. An aquifer test is required prior to the completion of the subdivision. We are
therefore applying for permits to construct 3 wells on the property to complete the
aquifer test. The locations of the wells are shown on the attached drawings. Please
refer the information and issue the permits so the well can be constructed and the test
completed.
Please let me know if you have additional questions.
Feb -24. 2004 10:I6AM 9015226119 No -5361 P. 14/15
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• tom Municipality of Anchorage
.�' On-Site Water and Wastewater Program
(907) 343-7904 s, F E T Y
Certificate of On-Site Systems Approval
Parcel I.D. 015-292-49 Expiration Date: I 0 "2-C9 `11
1. GENERAL INFORMATION
Complete legal description Forest Creek, Lot 1
Location (site address) 10161 Our Road
Current Property owner(s) Andrew Wakefield Day phone
Mailing address 10161 Our Rd, Anchorage, AK 99507
Real Estate Agent Shannon Ingram Day phone 748-7861
2. TYPE OF DWELLING:
El Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
4. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual
Individual Water Storage ❑ Holding Tank ❑
Community Class Well ❑ Community ❑
Public Water System ❑ Public Sewer ❑
WaiverNariance request for: Distance:
Received by: ,00/0/60 fiV. Date: I/ i4/I /
COSA to be released to the engineer,unless otherwise requested by the engineer.
COSA Fee $ 5.9 Waiver Fee $
Date of Payment .3-1(94R Date of Payment
Receipt Number (i 3 - ' C Receipt Number
COSA# 3C f -12 t2 Waiver#
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On-Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address 1399 W 34th Ave, Anchorage, AK 99503
Engineer's Printed Name Benjamin Schiller Date 7-16-2017
o
1:77 e 49ii-+ P. • •�
6. DSD SIGNATURE o 'ems
System #1 Approved for tok � .e. ..,•u •
pp 5 bedrooms d • a: •°.
}3•It! j '`T ea w
System #2 Approved for bedrooms vt, ,, -12592 .; 4,
Disapproved i4JI41
Conditional approval for bedrooms, with the following stipLili tl' trtsr
ON-SITE
WATER AND i`'
WASTEWATER c
PROGRAM
Original Certificate Date: 7-2._c_5 —
The
—ZC5 —The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On-Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS: `r
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other •
COSA blue sheet r .. c
If more than 1 septic system is on the lot:
COSA Checklist# of
Structure served by this system
Certificate of On-Site Systems Approval Checklist
Legal Description: Forest Creek, Lot 1 Parcel ID: 015-292-49
A. WELL DATA
Well type Private If A, B, or C provide PWSID# _ Well Log (Y/N) Y
Date completed 4/24/08 Sanitary seal (YIN) Y Wires properly protected (Y/N) Y
Total depth 272 ft. Cased to 272 ft. Casing height(above ground) 31 in.
FROM WELL LOG AT INSPECTION
Date of test 4/24/08 7/14/17
Static water level 238 ft. 245 ft.
Well production 10.0 g.p.m. 4.7 g.p.m.
WATER SAMPLE RESULTS:
Coliform l••;I. , colonies/100 mL Nitrate -1. mg/L
Arsenic t..,'. . ug/L Date of sample: ? - 5= 1-7 Collected by: Anderson Eng
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material Septic / Steel Date installed 4/1 6/08
Tank size 1 500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout(Y/N) Y - Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 7 - ZC0-! I7 Pumper A+ Home Services
C. ABSORPTION FIELD DATA
Date installed 4/16/08 Soil rating (g.p.d./ft2 or ft2/bdrm) 1 .2 gpd/sf System type 5-Wide
Length 63 ft. Width 5'0 ft. Gravel below pipe 4.0 ft.
Total depth
13.6 ft. Eff. absorption area 630 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 7/1 4/1 7 Results (Pass/Fail) Pass For 5 bedrooms
Fluid depth in absorption field before test 2 in. Water added 750 gal. New depth 27 in.
Elapsed Time: 1 440 min. Final fluid depth 2 in. Absorption rate >= 750 g.p.d.
No
Any rejuvenation treatment (past 12 mo.) (Y/N &type) If yes, give date
D. LIFT STATION
Date installed Size in gallons Manhole/Access (Y/N)
"Pump on" level at in. "Pump off' level at in. High water alarm level at in.
Datum Cycles tested Meets alarm&circuit requirements?
E. SEPARATION DISTANCES
WELL ON LOT TO:
Septic tank/lift station on lot >100' On adjacent lots >1001
Absorption field on lot '100 On adjacent lots >100'
Public sewer main >75' Public sewer manhole/cleanout >100'
Sewer/septic service line >25' Holding tank >75'
Animal containment areas >50' Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
>5' >5' >5'
Building foundation Property line Absorption field
Water main
>10' Water service line >10'0 Surface water >100'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line Building foundation >10 Water main _ X10
Water Service line Surface water >100Driveway, parking/vehicle storage >10'
Curtain drain None Noted Wells on adjacent lots '100'
F. COMMENTS
G. ENGINEER'S CERTIFICATION •�¢� •Or�el4 �Od
�
I certify that I have determined through field inspections and .... dA
review of Municipal records that the above systems are in 0 : 4q:Ili f" 1. •v I.conformance with MOA COSA guidelines in effect on this date. 0 .,
Benjamin Schiller • -°•••'
Engineer's Printed Name / in )1 $Chit!@!' .
Date 7/16/17 �i '•, GE-12532 ;
;e' ,'••7/I(.-((7
COSA brown sheet 10-10-12.doc
2005-83
FOREST CREEK SUBDIVISION
LOT 1
40,122 S.F.
S 89'56'46-E 299.42'
• •
. •
SEPTIC SYSTEIJ
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- 6•0' 1 ? =30'
0' EXISTING BUILDING •0
A.C. DRIVE '°
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WELL
i 0• T. & E. ESOT. "'
♦
217.4' A :te =A ---rI• 22 4'
S 89'55'451 299.42' A } `FENCE (APx)
AS - BUILT I HEREBY CERTIFY THAT I HAVE SURVEYED THE
PROPERTY DEPICTED ABOVE AND THAT NO *1tr
�� +
GASTALDI LAND
ENCROACHMENTS EXIST EXCEPT AS INDICATED.
SURVEYING, LLC ♦ F, �� A.. '�
IT IS THE RESPONSIBILITY OF THE OWNER TO ♦ '� •••••••. 4
JEFF A. GASTALDI, R.L.S. DETERMINE THE EXISTENCE OF ANY EASEMENTS. t'�Q. •
4. . �'
2000 E. DOWUNG RD., SUITE 8 COVENANTS OR RESTRICTIONS WHICH DO NOT *C°:: 4gl�i d' *•f
ANCHORAGE, ALASKA 99507 APPEAR ON THE RECORDED SUBDIVISION PLAT. as s
PHONE 248-5454 UNDER NO CIRCUMSTANCES SHOULD ANY DATA
lipt.3,44------1,-4........„_
GR.D DATE HEREON BE USED FOR CONSTRUCTION OR FOR ` v J�H�ry A. Gastalal 1
2537 8/26/�C:.B ESTABLISHING BOUNDARY OR FENCE LINES. ♦ '�,.•.� Ls-��1 ,:� •
ANCHORAGE RECORDING DISTRICT, ALASKA �. •aP•'••••••••• t.
F.B. JOB NO. `4 rCf•1f10nOt'' +•
08-07 FCS1 NOTE: NO CORNERS SET THIS DATE +alias1'‘w
• Municipality of Anchorage Gr,' Q
Apt. L.
•
�
,1��_i° Development Services Department
Building Safety Division SAFETY
On-Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907) 343-7904
Nitrate Advisory
Certificate of On-Site Systems Approval # OSC 171298
A Certificate of On-Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block 1, Lot
of Forest Creek subdivision. This inspection revealed a nitrate
concentration of 7.82 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On-
Site Systems Approval.
Nitrate Fact Sheet
From Northern Testing Laboratories,Inc.
Nitrate is a negatively charged compound of nitrogen and oxygen, which is very soluble
in water. Nitrate is not readily filtered or otherwise removed in the soil and can pass
rapidly into ground water wells.
SOURCE: Nitrate is a major component of fertilizer and wastewater. Often the nitrate is
in the form of ammonia or protein first, which through contact with oxygen and certain
bacteria, converts to the oxidized form known as nitrate. Sources of nitrate from
wastewater include urea, ammonia cleaners, food solids, and bacterial cells. It may also
result from the breakdown of organic matter buried in the soil.
TOXICITY: Nitrate is generally not toxic to adults or children over the age of two or
three years, but is associated with a potentially fatal infant disease called
methemoglobinemia. In the digestive system of young children, nitrate converts to
nitrite, which can pass through the intestinal wall into the blood stream. There it
combines with the hemoglobin and interferes with the ability of the blood to carry
oxygen. For this reason, methemoglobinemia is referred to as "blue baby" disease. The
EPA limits the concentration of nitrate in public drinking water supplies to 10 mg/L. The
standard has been lowered from a previous level of 45 mg/L set by the US Public Health
Service and the World Health Organization.
TREATMENT: due to its solubility in water and negative ionic charge, filtration and
other common home water treatment systems such as softening or iron filtration does not
readily remove nitrate. The best method for limiting nitrate in well water is source
control. This can include avoiding overdosing of fertilizer near the well and maintaining
good separation distances between septic tank leach fields and the well. A special anion
exchange filter that contains a media with a strong affinity for negatively charged ions in
water, or by a reverse osmosis treatment system or distillation can remove nitrate.
TESTING: Nitrate analysis is usually done by one of the several "wet chemical"
methods using a spectrophotometer to read the final color endpoint. Specific ion
electrodes also can be used to detect the activity of nitrate in water. This laboratory uses
several different wet chemical methods approved under the public water supply
laboratory certification program. They also have test kits available, which the laboratory
uses to perform an inexpensive "screening test", and with which the homeowner can
monitor the change in nitrate levels from their well. They recommend comparing the test
kit results against a certified analysis from the lab occasionally to verify the accuracy of
the kit. We recommend using a specially prepared bottle that has been rinsed in
hydrochloric acid for collecting samples.
• Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Parcel I. D.
015-292-46
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description
Location (site address)
FOREST CREEK LOT 1
Expiration Date: tl _o? 3 -
10161 OUR RD., ANCHORAGE, AK 99516
Current Property owner(s) RONEL STEPHENS
Mailing address
Real Estate Agent
MARY STEPHENS
2. TYPE OF DWELLING:
(] Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 5
Day phone
Day phone 273-7706
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
0
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
Waiver/Variance request for: NONE Distance:
Received by: l! )'r a> -- Date:
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ !_i I 0 / Waiver Fee $ _
Date of Payment -7 ��i I Z 3 Date of Payment
Receipt Number U 7 w Receipt Number
COSA # / 3 /.3 3 1? Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING Phone 279-3916
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
System #1 Approved for S� bedrooms
System #2 Approved for bedrooms
Disapproved
Date 1121L19.. _°_...,; i
s @t{d
Conditional approval for bedrooms, with the following stipulations:
By: �a• Original Certificate Date: 1 — 02- 3 _/
The niId nchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet f , -
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: FOREST CREEK LOT 1
A. WELL DATA
Well type PRIVATE If A, B. or C provide PWS ID # -
Date completed 4/19/08 Sanitary seal (Y/N) Y
Total depth 272 ft. Cased to 272 ft.
FROM WELL LOG
Date of test 4/19/08
Static water level 238
Well production
10
WATER SAMPLE RESULTS
ft.
Coliform NEG colonies/100 mL Nitrate 6.32 mg/L
Arsenic ug/L Date of sample: 1/10114
B. SEPTIC/HOLDING TANK DATA
Tank Type/Material SEPTIC/ STEEL
Tank size 1500 gal. Number of Compartments 2
Foundation cleanout (Y/N) Y
Date of pumping 7/15113
C. ABSORPTION FIELD DATA
Date installed 4116/08
Parcel I D: 015-292-49
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24 in.
AT INSPECTION
6/18/13
245
3.2
ft.
Collected by: Lars Spurkland
Depression over tank (Y/N) N
Pumper A+ HOME SERVICES
Soil rating (g.p.d./ft2 or ft2/bdrm) 1_2
Date installed 4/16/08
Cleanouts(Y/N) Y
High water alarm (Y/N) N
System type 5 -WIDE
Length 63 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 14 ft. Eff. absorption area 630 fe Monitoring tube Y Depression over field N
Date of adequacy test 6/18/13 Results (Pass/Fail) PASS For 5 bedrooms
Fluid depth in absorption field before test 14,0 in. Water added 610 22.5,3
p rp gal. New depth in.
Elapsed Time: 20 min. Final fluid depth 19'0 in. Absorption rate >= 750 9 p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date -
D. LIFT STATION
Date installed
"Pump on" level at _
Datum
Size in gallons
Manhole/Access(Y/N)
in. "Pump off' level at in. High water alarm level at in.
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tank/lift station on lot >100' -
Absorption field on lot >100'
Public sewer main »5
Sewer /septic service line 25
Animal containment areas >50'
Meets alarm & circuit requirements?
On adjacent lots >100,
On adjacent lots >100,
Public sewer manhole/cleanout >100,
Holding tank NA
Manure/animal excrete storage areas >100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5
Water main NA Water service line >10
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10 Building foundation >10,
Water Service line >10 Surface water >100'(N.O.)
>50' (N.O.) >100,
Curtain drain Wells on adjacent lots
F. COMMENTS
* Arsenic Sample Date 6-18-13
G. ENGINEER'S CERTIFICATION
t certify that l have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKAND
Date 1/21114
COSA brown sheet -1 0-10-1 2.doc
Absorption field >5
Surface water >100' (N.O.)
Water main NA
gNehicle
Driveway, arkin >25
y p storage
9 spuNmfid Enah emong
Environmental Consulting and Design
0 1
SEPTIC SYSTEM DESIGN
Municipality of Anchorage January 22, 2014
Development Services Department
On Site Water and Wastewater Program
4700 Elmore Road
Anchorage, Alaska 99519
Subject: COSA- Forest Creek Lot 1
Ladies and Gentlemen:
On June 18, 2013 the septic system at the above reference property was tested. The septic
system was design for a 5 bedroom single family residence and consists of a 1500 gallon steel
septic tank and a shallow trench absorption field with four feet of effective absorption depth.
Prior to the testing on June 18th, a liquid level of 14 inches and 0 inches were observed in each of
the trench monitor tubes. A total of 610 gallons was added to the absorption field, causing the
liquid level in each monitor to rise 8.5 and 3 inches respectively. During a 20 min period the
liquid level dropped 3.5 and 3 inches in each monitor tube. A calculated absorption rate of 14.4
gallons per minute was observed during the recovery period. The equals in excess of 20,000
gallons per day, greatly exceeding the minimum required for a 5 bedroom system (750 gpd).
A well production rate of 3.2 gallons per minute was observed. This also exceeds the minimum
required for a 5 bedroom residence (0.52 gpm).
If you have any questions or concerns, please contact me at 279-3916.
Lars S urkland. P.E.
203 West 15th Avenue Suite 203, Anchorage, AK 99501, Phone: (907) 279-3916
Fax: (866) 354-1597, Lspurkland@gci.net
• '� Municipality of Anchorage
`>.
On -Site Water and Wastewater Program
(907)343-7904 �^
s =e„
Certificate of On -Site Systems Approval
Parcel I.D. 015-292-46 Expiration Date: "I /Z 1 �1 `i
1
GENERAL INFORMATION
Complete legal description FOREST CREEK LOT 1
Location (site address) 10161 OUR RD., ANCHORAGE, AK 99516
Current Property owner(s) RONEL STEPHENS
Mailing address
Real Estate Agent
MARY STEPHENS
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone 273-7706
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverNariance request for: NONE Distance:
Received by: " f tl� l %' Date. 6 i1'
COSA to be released to the eng(neer, unless otherwise requested by the engineer. -
COSA Fee $ Lq Go
Date of Payment 717113
Receipt Number 02557 G
COSA # 05G / 3133 5
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING Phone 279-3916
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
✓ System #1 Approved for r bedrooms
System #2 Approved for bedrooms
Disapproved
Date 1121/14
Conditional approval for bedrooms, with the following stipulations:
,,.
By: k1nk/ f, � 3e ODed" (rc cer+; s,ca+ Original Certificate Date: 7,A-311-3
The Municipality of Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA blue sheet -E -
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: FOREST CREEK LOT 1
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID # -
Date completed 4/19/08 Sanitary seal (YIN) Y
Total depth 272 ft. Cased to 272 ft.
FROM WELL LOG
Date of test 4/19/08
Static water level 238
Well production 10
WATER SAMPLE RESULTS
P
..-
Coliform NEG colonies/100 mL Nitrate 6.32 mg/L
Arsenic ND I ug/L Date of sample: 1/10/14
4 61163/ 1_5
B. SEPTIC/HOLDING TANK DATA
Parcel ID: 015-292-49
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24 in.
AT INSPECTION
6/18/13
245
3.2
ft.
NO00
Collected by: Lars Spurkland
Tank Type/Material SEPTIC/ STEEL Date installed 4/16/08
Tank size 1500 gal. Number of Compartments 2 Cleanouts (Y/N) Y
Foundation cleanout (Y/N) Y Depression over tank (Y/N) N High water alarm (Y/N) N
Date of pumping 7/15/13 Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date installed 4/16/08
Length 63 ft.
Soil rating (g.p.d./ft2 or ft2/bdrm) 1_2
System type 5 -WIDE
Width 5 ft. Gravel below pipe 4 ft.
Total depth 14 ft. Eff. absorption area 630 ft2 Monitoring tube Y Depression over field N
Date of adequacy test 6/18/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 14 in. Water added 610 gal. New depth 22.5 in.
Elapsed Time: 20 min. Final fluid depth 19 in. Absorption rate >= 600 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date -
D. LIFT STATION
Date installed Size in gallons
"Pump on" level at in. "Pump off" level at
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tank/lift station on lot '100' -
Absorption field on lot '100'
Public sewer main '75
Sewer /septic service line '25
Animal containment areas '50'
Manhole/Access(Y/N)
in. High water alarm level at in.
Meets alarm & circuit requirements?
On adjacent lots '100'
On adjacent lots '100'
Public sewer manhole/cleanout '100'
Holding tank NA
Manure/animal excrete storage areas '100'
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation 'S Property line >5
Water main NA Water service line '10'
Wells on adjacent lots '100'
ABSORPTION FIELD ON LOT TO:
Property line '10 Building foundation '10'
Water Service line '10'
Curtain drain '50' (N.O.)
F. COMMENTS
G. ENGINEER'S CERTIFICATION
Surface water '100'(N.O.)
Wells on adjacent lots '100'
1 certify that / have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKAND
Date 1121/14
COSA brown sheet 10-10-12.doc
Absorption field's
Surface water '100' (N.O.)
Water main NA
Driveway, parking/vehicle storage25�
Iq
Parcel I.D. 015-2924
�P4
Municipality of Anchorage
On -Site Water and Wastewater Program
(907)343-7904
Certificate of On -Site Systems Approval
1. GENERAL INFORMATION
Complete legal description FOREST CREEK LOT 1
Expiration Date: / 0 a 3-13
Location (site address) 10161 OUR RD., ANCHORAGE, AK 99516
Current Property owner(s) RONEL STEPHENS
Mailing address
Real Estate Agent
MARY STEPHENS
2. TYPE OF DWELLING:
Fx� Single Family (w/wo ADU)
❑ Duplex
❑ Multiple Dwellings (Single Family and/or Duplex)
3. NUMBER OF BEDROOMS: 4
Day phone
Day phone 273-7706
4. TYPE OF WATER SUPPLY:
TYPE OF WASTEWATER DISPOSAL:
Individual Well
El
Individual
0
Individual Water Storage
❑
Holding Tank
❑
Community Class Well
❑
Community
❑
Public Water System
❑
Public Sewer
❑
WaiverA.ariance request 'or: NONE Distance: ---
Received by _"L Date
COSA to be released to the engineer, unless otherwise requested by the engineer.
COSA Fee $ l o
Date of Payment 1 111
Receipt Number Oo't JrJ 1 tn'
COSA# 65L t ?-) 1335
Waiver Fee $
Date of Payment
Receipt Number
Waiver #
5. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my investigation,
based on procedures outlined in the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) in compliance with all applicable Municipal and State codes,
ordinances, and regulations in effect at the time of installation.
Name of Firm SPURKLAND ENGINEERING
Address 203 W. 25TH AVE.,STE.202A, ANCHORAGE, AK 99501
Engineer's Printed Name LARS SPURKLAND
6. DSD SIGNATURE
_,z System #1 Approved for Tj / bedrooms
System #2 Approved for bedrooms
Disapproved
Phone 279-3916
Date 7/8/13
\�
OF qq lit
49
LA aXSPU�F�1,KLAND.,t2j:
i roo/
Conditional approval for bedrooms, with the following stipulations:
By: Z41, Original Certificate Date: / -,2 3
The' nib' al�/ Anchorage Development Services Division (DSD) issues Certificates of On -Site Systems Approval (COSA) based only
upon the representations given in paragraph 5 by an independent professional civil engineer registered in the State of Alaska. The Municipality
of Anchorage is not responsible for errors or omissions in the professional engineer's work.
7. ATTACHMENTS:
COSA Checklist X Nitrate Advisory
Septic System Advisory Arsenic Advisory
Well Flow Advisory Other
COSA bluesheet f y c
If more than 1 septic system is on the lot:
COSA Checklist # 1 of 1
Structure served by this system 1
Certificate of On -Site Systems Approval Checklist
Legal Description: FOREST CREEK LOT 1
A. WELL DATA
Well type PRIVATE If A, B, or C provide PWSID #
Date completed 4119108 Sanitary seal (Y/N) Y
Total depth 272 ft. Cased to 272 ft.
Parcel ID: 015-292-49
Well Log (YIN) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24 in.
FROM WELL LOG AT INSPECTION
Date of test 4/19/08 6/18/13
Static water level 238 ft 245 ft
Well production 10 g.p.m. 32 g.p.m.
WATER SAMPLE RESULTS
Coliform NEG colonies/100 mL Nitrate 9.17 mg/L
Arsenic ND ug/L Date of sample: 6/18/13
Collected by: ANSON MOXNESS
B. SEPTICIHOLDING TANK DATA
Tank Type/Material SEPTIC/ STEEL Date installed 4/16/08
Tank size 1500 gal. Number of Compartments Cleanouts (YIN) Y
Foundation cleanout (Y/N) Y
Date of pumping 7/XX/13
Depression over tank (Y/N) N High water alarm (YIN) N
Pumper A+ HOME SERVICES
C. ABSORPTION FIELD DATA
Date installed 4/16108 Soil rating (g.p.d./ftZ or ft2/bdnn) 1.2 System type 5 -WIDE
Length 63 ft. Width 5 ft. Gravel below pipe 4 ft.
Total depth 14 ft. Eff. absorption area 630 fe Monitoring tube Y Depression over field N
Date of adequacy test 6118/13 Results (Pass/Fail) PASS For 4 bedrooms
Fluid depth in absorption field before test 14 in. Water added 610 gal. New depth 225= n.
Elapsed Time: 20 min. Final fluid depth 19 in. Absorption rate >= 600 g p d
Any rejuvenation treatment (past 12 mo.) (Y/N & type) NO If yes, give date —
D. LIFT STATION
Date installed Size in gallons _ Manhole/Access (YIN)
"Pump on" level at in. "Pump off' level at in. High water alarm level at
Datum
E. SEPARATION DISTANCES
WELL ON LOT TO:
Cycles tested
Septic tank/lift station on lot >100' -
Absorption field on lot >100'
Public sewer main >75
Sewer /septic service line >25
Animal containment areas >50'
Meets alarm & circuit requirements?
On adjacent lots >100,
On adjacent lots >100,
Public sewer manhole/cleanout >100,
Holding tank NA
Manure/animal excrete storage areas >100,
SEPTIC/HOLDING TANK ON LOT TO:
Building foundation >5 Property line >5
Water main NA Water service line >10'
Wells on adjacent lots >100'
ABSORPTION FIELD ON LOT TO:
Property line >10 Building foundation >10,
Water Service fine >10' Surface water >I00'(N.O.)
Curtain drain >50' (N.O.) Wells on adjacent lots >100,
F. COMMENTS
G. ENGINEER'S CERTIFICATION
I certify that t have determined through field inspections and
review of Municipal records that the above systems are in
conformance with MOA COSA guidelines in effect on this date.
Engineer's Printed Name LARS SPURKAND
Date 7/8/13
COSA brown sheet 10-10-12.doe
Absorption field >5
Surface water >100' (N.O.)
Water main NA
Driveway, parking/vehicle storage >25
Municipality of Anchorage s ,
Community Development Department
Development Services Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 131335
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
1 of Forest Creek subdivision. This inspection revealed a nitrate
concentration of 9.17 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.
Municipality of Anchorage
Development Services Department
Building Safety Division
Onsite Water and Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995196650
www.muni.org/onsite
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL
FOR A SINGLE FAMILY DWELLING Qp x
Parcel I.D. 015-29249 COSA # [)00✓�
Expiration Date: / — f — d
1. GENERAL INFORMATION
Complete legal description Lot 1, Forest Creek Subdivision
Location (site address) 10161 Our Road Anchorage, AK 99516
Current Property owner(s) The Dittrich Company Day phone 632-8970
Mailing address P.O. Box 90411 Anchorage, AK 99509
Lending agency Day phone
Mailing address
Real Estate Agent Day phone
Mailing Address
Unless otherwise requested, COSA will be held by DSD for pickup.
2. NUMBER OF BEDROOMS: Five (5)
3. TYPE OF WATER SUPPLY: TYPE OF WASTEWATER DISPOSAL:
Individual Well Individual On-site
❑d
Individual Water Storage ❑ Individual Holding Tank
❑
Community Class Well ❑ Community On-site
❑
Public Water System ❑ Public Sewer
❑
The Municipality of Anchorage Development Services Department (DSD) issues Certificates of On -Site Systems
Approval (COSA) based only upon the representations given in paragraph 4 by an Independent professional civil
engineer registered in the State of Alaska. Certificates of Onsite Systems Approval are required for the transfer of
title (except between spouses) for properties served by a single-family on-site wastewater disposal and/or water
supply system. DSD also issues COSAs upon request to homeowners. Certificates of Onsite Systems Approval
are valid for 90 days from the date of issue for properties served by a private or Class C well and may be reissued
with new water sample results. (Certificates may be reissued for a period of up to one year with valid water
samples.) Certificates are valid for one year for properties served by Class A or B wells or a public water system.
The Municipality of Anchorage is not responsible for errors or omissions in the professional engineer's work.
4. STATEMENT OF INSPECTION BY ENGINEER
As certified by my seal affixed hereto and as of the validation date shown below, I verify that my Investigation,
based on procedures outlined In the Certificate of On -Site Systems Approval Guidelines for this application,
shows that the on-site water supply and/or wastewater disposal system is (are) safe, functional and adequate
for the number of bedrooms and type of structure indicated herein. I further verify that based on the information
obtained from the Municipality of Anchorage files and from my Investigation and inspection, the on-site water
supply and/or wastewater disposal system is(are) In compliance with all applicable Municipal and State codes,
ordinances, and regulations In effect at the time of installation.
Name of Firm Anderson Engineering Phone 522-7773
Address P.O. Box 240773 Anchorage. AK 99524
Engineer's Printed Name Michael E. Anderson, P.E. Date SIM=
* 491H
6. DSD SIGNATURE Ir"- Q a 50'x: � i
I. Ir" - CE -4381 �..'
�Approvedfor bedrooms. i@epfo.9�zt�?�•��4
Disapproved. t��1 fta`ss oO-'
Conditional approval for bedrooms, with the following stipulations:
Attachments:
COSA Checklist
Septic System Advisory
Well Flow Advisory
Nitrate Advisory
X
Arsenic Advisory
Maintenance Agreements
Supplemental Engineer's Report
Other
By: Original Certificate Date: 0 O
(rs« 11M)
Municipality of Anchorage •,,
Development Services Department
Building Safety Division '
' On -Site Water& Wastewater Program
4700 Bragaw Street
P.O. Box 196650
Anchorage, AK 995196650
www.muni.org/onsfte
(907)343-7904
CERTIFICATE OF ON-SITE SYSTEMS APPROVAL CHECKLIST
Legal Description: Lot 1. Forest Creek Subdivision Parcel ID: 015-29249
A. WELL DATA
Well type Pdvate
Date completed 479/08
Total depth 272 ft.
Date of test
Static water level
Well production
If A. B, or C provide PWSID # _
Sanitary seat (Y/N) Y
Cased to 272 fL
FROM WELL LOG
4119108
238 ft.
WATER SAMPLE RESULTS:
10
Coliform 0 colonies/100 mL
Arsenic: NID mg/1
_ 9 -P.M.
Well Log (Y/N) Y
Wires properly protected (Y/N) Y
Casing height (above ground) >24 in.
AT INSPECTION '
ft.
g.p.m.
Nitrate 7.72 mg/I Other bacteria 0 colonies/100 mL
Date of sample: 9m�s Collected by: J. Davis
B. SEPTICIHOLDING TANK DATA
Tank Type/Material Septic/Steer
Tank size ,1,500 gal. Number of Compartments Two
Foundation cleanout (Y/N) Y Depression over tank (YM) N
Date of pumping New Conswction Pumper
Date installed 4i1e10e
Cleanouts (Y/N)_
High water alarm (Y/N)
Y
N
C. ABSORPTION FIELD DATA
Date installed 4/18108 Soil rating (g.p.dAlt or ft=/bdrn) t2 GPD1SF System type S vnde Trend,
Length 83 ft. Width 5 ft. Gravel below pipe 4 R
Total depth 12-13 ft. Eff. absorption area 830 ft2 Monitoring tube Y Depression over field N
Date of adequacy test New Const. Results (Pass/Fail)For_bedrooms
Fluid depth in absorption field before test in. Water added Bal. .New depth in.
Elapsed Time: min. Final fluid depth in. Absorption rate >= g.p.d.
Any.rejuvenation treatment (past 12 mo.) (Y/N & type) N If yes, give date
D. LIFT STATION
�+rVl4 •'�J;f t,
N
Date installed Size in gallons
Manhole/Access (Y/N)
'Pump on' level at — In. 'Pump oft level at_
in. High water alarm level at . In.
Datum Cycles tested
Meets alar 8 circuit requirements?
E. SEPARATION DISTANCES
.Mrd1a
' yO : 2t t7WDER5pry �� r
SEPARATION DISTANCES FROM WELL ON LOT TO:
G��✓�E''i38� �\y=
/ O v
Septic tankAift station on lot 21100'
On adjacent lots 21100•
Absorption field on lot >100'
On adjacent lots >100,
Public sewer main WA
Public sewer manhole/cleanout WA
Sewer/septic service line >25'
Holding tank WA
Animal containment areas None
Manurelanimal excrete storage areas None
SEPARATION DISTANCES FROM SEPTICIHOLDING TANK ON LOT TO:
Building foundation >S Property line>S
Absorption field >5'
Water main 2110' Water service line
2110 Surface water >100,
Wells on adjacent lots >100'
SEPARATION DISTANCE FROM ABSORPTION FIELD ON LOT TO:
Property line >10' Building foundation >10' Water main >10'
Water Service line >70' Surface water >100'
Driveway, parkingtvehicie storage >2S
Curtain drain None Noted Wells on adjacent lots >100!
F. COMMENTS -
44
G. ENGINEER'S CERTIFICATION
�+rVl4 •'�J;f t,
N
1 cer* that I have determined through field inspections and
•.9
y * • ,49-TH , • *�0
• 10
review of Municipal records that the above systems are in
P 1 s
...% ..
conformance with MOA COSA guidelines In effect on this date.
�.... ..�•00
�
^ •••••••r
.Mrd1a
' yO : 2t t7WDER5pry �� r
Engineer's Printed Name Michael E. Anderson, P.E.
G��✓�E''i38� �\y=
/ O v
Date 9182008
r,✓I �� pB!)ireeinNp` wva
COSA Fee $_
Date of Payment
Receipt Number,
(Rev. 11/05)
Waiver Fee $
Date of Payment
Receipt Number
Municipality of Anchorage r ,
`•� Development Services Department
./ Building Safety Division
On -Site Water and Wastewater Program
4700 Elmore Street
P.O. Box 196650 Anchorage, AK 99519-6650
www.muni.org/onsite
(907)343-7904
Nitrate Advisory
Certificate of On -Site Systems Approval # 80332
A Certificate of On -Site Systems Approval inspection and test of potable
water was recently conducted on the well water supply on Block , Lot
1 of Forest Creek subdivision. This inspection revealed a nitrate
concentration of 7.72 milligrams per liter (mg/L) was reported for the
property's well water sample. The Environmental Protection Agency (EPA)
has established a maximum contaminant level (MCL) of 10.0 mg/L for
public drinking water systems. While private wells are not subject to this
regulation, EPA standards are based on existing health information and can
therefore be used to gauge the relative quality of water from private wells.
Please see the attached "Nitrate Fact Sheet" for important information
regarding nitrate.
This advisory must be attached to all copies of the subject Certificate of On -
Site Systems Approval.